Educational Approach and Quality: Does PBL support quality learning outcomes?

1. Educational Approach and Quality:Does PBL support quality learning outcomes? Tracey Winning School of Dentistry The University of Adelaide

2. Educational Approach and Quality • Objectives • To share knowledge and experience of learning and teaching in PBL  review published outcomes of PBL

3. Why PBL? Quality Student Experience • Student-centred focus 1, 2 • Improve integration of basic science and clinical education 1, 2 • Develop skills, understandings, qualities and dispositions appropriate to employment:3 • life-long learning, critical thinking and decision making, independent working, teamwork, flexibility, oral communication, time management, planning and organisational ability • Evidence-based decision making approach for patient management 4 1. Institute of Medicine, 1995; 2. General Dental Council, 2002; 3. The Pedagogy for Employability Group, HEA, 2006; 4. Institute of Medicine 2003

4. Why PBL?Learning Theories : Social constructivism Meaningful learning is most likely with: 5, 6, 7 • authentic, real activities, • modelling and coaching, ie, how to think and act as a practitioner, • interactions: ‘inquiry and exploratory talk,’ 8 • collaboration: students and staff, • reflection: content and strategies, • working independently: staff step back. • Co-construction of new knowledge for ‘real-world’ contexts, linked to prior knowledge. These elements inform the design of problem-based learning (PBL) with the aim to support meaningful student learning. 9 5. Brown et al. 1989; 6. Savery & Duffy, 1995; 7. Brophy, 2002; 8. Wells, 2002; 9. Dolmans et al., 2005

5. Principles Problem = organiser for learning Learner-centred Educational approach (not a method) Characteristics Problem = authentic professionally relevant situation Encountered first Student responds as practitioner Students involved in deciding what, how to learn Construct own knowledge & understanding Guidance/scaffolding provided by teacher as a ‘facilitator’ of learning Multiple learning and teaching methods Organised around problem: small groups, collaborative & independent research, peer learning and teaching, reflection and self-management What is PBL? 10, 11 10. Barrows 2000; 11. Charlin et al., 1998

6. What is PBL? Educational Outcomes10 • Systematic approach to patient and analysis of their situation • Contextualised and integrated knowledge, skills, behaviours • Self-directed (independent) learning skills, lifelong • Team skills • Motivating, enjoyable learning experience 10. Barrows 2000

7. PBL Package Purpose Package must provide opportunity for students to: 12 • Think and act as practitioner • develop new, professional knowledge, skills and behaviours • apply new, professional knowledge, skills and behaviours • Develop learning skills • collaborative, independent study • discussion and critique of learning  Is there support that PBL can achieve these educational outcomes? 12. Adapted from PROBLARC 2000

8. Outcomes: Systematic approach to analysis of patient situation • Developing systematic enquiry skills: • Graduates self-rated as better at problem-solving skills 13 • Improvement in clinical reasoning strategy more accurate hypotheses and coherent explanations with basic science knowledge 14 • Improved diagnostic ability with PBL using clinical contexts 15 13. Schmidt et al., 2006; 14. Hmelo, 1998; 15. Schmidt et al., 1996

9. Outcomes: Contextualised and integrated knowledge, skills, behaviours • Basic and clinical science knowledge • Critical thinking, logical argument (eg explain, test, justify their assumptions, knowledge, reasoning) • Communication/interpersonal skills • Preparation for practice and clinical skills

10. Outcomes: knowledge, skills, behaviours 1 • Basic and clinical science knowledge • Several reviews have reported equivocal outcomes re basic science knowledge development 16, 17, 18 • Better skills in applying knowledge 18 • Significantly better performance on Medical Board exams (I & II) 19 • Critical thinking • Higher critical thinking disposition which was maintained (to a lesser degree over subsequent 2 y) 20 16. Albanese & Mitchell, 1993; 17. Vernon & Blake, 1993; 18. Dochy et al., 2003; 19. Hoffman et al., 2006; 20. Tiwari, et al., 2006

11. Outcomes: knowledge, skills, behaviours 2 • Communication /interpersonal skills • High levels of communication skills in PBL graduates (self 13 and clinical directors/co-workers 21, 22) • Preparation for practice • Graduates felt better prepared than their peers from conventional curricula 23 • Graduates self-rated as better at professional skills (eg physical examination) 13 and were rated above average by clinical directors 22 • Better clinical periodontics performance in OSCE (NS difference for examination of patient) 24 13. Schmidt et al., 2006; 21. Rolfe and Pearson, 1994; 22. Dean et al., 2003; 23. Mennin et al., 1996; 24. Rich et al., 2005

12. Identifying own learning needs and resources Information literacy skills (eg identify, locate, evaluate and use information) Identifying and utilising appropriate learning processes (eg self-testing, concept maps, diagrams, teaching others, applying knowledge to novel situations) Developing time management and organisational skills Monitoring and evaluating learning processes and outcomes Outcomes: Self-directed learning

13. Identifyingneeds and resources: > 60% (average) learning issues match faculty-identified learning issues; identify other relevant learning issues 25, 26 plan and undertake research in own time, using self-identified resources 27 Informationliteracy skills Graduates self-rated as better at self-directed learning 13, 22 and using information resources 13 Outcomes: Self-directed learning 1 13. Schmidt et al., 2006; 22. Dean et al., 2003; 25. Dolmans et al., 1993; 26. Sigrell et al., 2004; 27. Blumberg 2000

14. Outcomes: Self-directed learning 2 • Learning processes/approaches • PBLassociated with learning for meaning (deep) 28, 29, 30, 31 • Developingtime management and organisational skills • Graduates self-rated as better at planning, efficiency and time management 13, 22 and rated highly by clinical directors 22 • Monitoringand evaluating learning processes and outcomes: • Updating of current knowledge for practice 32 13. Schmidt et al., 2006; 22. Dean et al., 2003; 28. Coles, 1985; 29. Newble and Clarke, 1986; 30. Vu et al., 1998; 31. Richardson et al., 2007, in press; 32. Shin et al., 1993

15. Outcomes: Team Skills • Group function: • Group dynamics • Working relationships (eg respect, trust, valuing, etc); • Communication (eg negotiation, discussion, giving and receiving feedback); • Conflict management, (eg trouble-shooting dysfunctional groups: domination, non-participation, exclusion, ‘short-cutting’, ‘sponging’) • Group process • Roles & responsibilities (eg leader, scribe, researcher, recorder/ administrator); • Monitoring and evaluating group functioning; • Organising

16. Outcomes: Team Skills • Group dynamics • Graduates self-rated as better collaboration skills 13, 22 • Group process • Graduates self-rated as better at skills required for running meetings 13 13. Schmidt et al., 2006; 22. Dean et al., 2003

17. Outcomes: Student satisfaction • improved enjoyment, student interaction, and flexibility in their programs 16, 30, 33, 34 • overall satisfaction strong for PBL experience 35 and better cf with conventional curricula (CEQ) 31 16. Albanese &Mitchell, 1993; 30. Tiwari et al., 2006; 31. Richardson et al., 2007, in press; 33. Rohlin et al., 1998; 34. Townsend et al., 1997; 35. Lyon and Hendry, 2002.

18. Conclusion • Evaluation of PBL indicates achieving some of educational outcomes; these link to quality higher education learning outcomes • Issues in interpreting results due to variable implementations of PBL and limited use of theoretical basis: need clear definition of programme processes to assist in interpretation 10, 11 • Research needed to identify key elements of context that are required to achieve PBL outcomes 9 9. Dolmans et al., 2005; 10. Barrows 2000; 11. Charlin et al., 1998

19. References 1 Albanese MA, Mitchell S. 1993 Problem-based learning: A review of literature on its outcomes and implementation issues. Acad Med 68(1): 52-81. Barrows H. 2000 Problem-based Learning Applied to Medical Education. Springfield, Illinois: Southern Illinois University School of Medicine Blumberg P. Evaluating the evidence that problem-based learners are self directed learners: A Review of the literature. In: Evensen D, Hmelo CE, eds. Problem- Based Learning: Research Perspectives on Learning Interactions. Mahwah; Lawrence Erlbaum Assoc, 2000:199-227 Brown JS, Collins A & Duguid P. 1989 Situated cognition and the culture of learning. Educational Researcher 18: 32-42 Brophy J. 2002 Introduction. In: Social Constructivist Teaching: Affordances and Constraints. Ed: Brophy J. JAI: Amsterdam pp ix-xxii. Charlin B, Mann K, Hansen P. 1998 The many faces of problem-based learning: a framework for understanding and comparison. Medical Teacher 20:323-330. Coles CR. 1985 Differences between conventional and problem-based curricula in their students’ approaches to studying. Med Educ 19(4):308-309. Dean SJ, Barrett AL, Hendry GD, Lyon PMA. 2003 Preparedness for hospital practice among graduates of a problem-based, graduate-entry medical program. MJA 178:163-167.

20. References 2 Dochy F, Segers M, Van den Bossche P, Gijbels D. Effects of problem-based learning: a meta-analysis. Learning and Instruction 2003;13:533-568. Dolmans DH, Gijselaers WH, Schmidt HG, van der Meer SB. 1993 Problem effectivenss in a course using problem-based learning. Acad Med 68(3):207-213. Dolmans D, De Grace W, Wolfhagen IHAP, van der Vleuten CPM. 2005 Problem-based learning: future challenges for educational practice and research. Med Educ 39:732-741. General Dental Council 2002 The First Five Years. General Dental Council, London. Hmelo CE 1998 Cognitive consequences of problem-based learning for the early development of medical expertise. Teach Learn Med 10(2):92-100. Hoffman K, Hosokawa M, Blake R Jr, Headrick L, Johnson G. 2006 Problem-based learning outcomes: ten years of experience at the University of Missouri - Colombia School of Medicine. Acad Med 81(7):617-625. Institute of Medicine 1995 The mission of education. In: Dental Education at the Crossroads: Challenges and Change (Report by Committee on the Future of Dental Education, Division of Health Services). Ed: Field MJ. National Academy Press, Washington. pp 88-143.

21. References 3 Institute of Medicine 2003 Health Professions Education: A bridge to quality. (Report by Committee of the Health Professions Education Summit). Eds: Greiner AC, Knebel E. The National Academies Press, Washington. http://www.nap.edu/catalog.php?record_id=10681#toc (accessed 11-9-07). Lyon PMA, Hendry GD. 2002 The use of the Course Experience Questionnaire as a monitoring evaluation tool in a problem-based medical programme. Assessment & Evaluation in Higher Education 27(4): 339-350. Mennin SP, Kalishman S, Friedman M, Pathak D, Snyder J. 1996 A survey of graduates in practice from the University of New Mexico's conventional and community-oriented, problem-based tracks. Acad Med 71: 1079-89. Newble DI, Clarke RM. 1986 The approaches to learning of students in a traditional and in an innovative problem-based medical school. Med Educ 20:267-273. PROBLARC 1994 Constructing a Problem. Workshop papers: Designing and Writing PBL Packages, June 30th and July 1st, 2001, Adelaide. Newcastle, NSW: Problem Based Learning Assessment and Research Centre, The University of Newcastle. Rich SK, Keim RG, Shuler CF. 2005 Problem-based learning versus traditional educational methodology: a comparison of preclinical and clinical periodontics performance. J Dent Educ 69(6): 649-662.

22. References 4 Richardson J 2007 Medical Teacher 29: in press Rohlin M, Petersson K, Svensbter G 1998 The Malmo model: a problem-based learning curriculum in undergraduate dental education. Eur J Dent Educ 2:103-114. Rolfe I, Pearson S. 1994 Communication skills of interns in New South Wales. MJA 161:667-670. Savery JR & Duffy TM. 1995 Problem-based learning: An instructional model and its constructivist framework. Educational Technology 135:31-38 Schmidt HG, Machiels-Bongaerts M, Hermans H, et al. 1996 The development of diagnostic competence: comparison of a problem-based, an integrated, and a conventional medical curriculum. Acad Med 71(6): 658-664 Schmidt HG, Vermeulen L, van der Molen HT. 2006 Longterm effects of problem-based learning: a comparison of competencies acquired by graduates of a problem-based and a conventional medical school. Med Educ 40:562-567. Sigrell B, Sundblad G, Rönnås P-A. 2004 To what extent do students generate learning issues that correspond to pre-set faculty objectives? Med Educ 26(4): 378-381.